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Toward a Common Secure Future: Recommendations From Four Global Health Commissions

WASHINGTON (May 19, 2016) - As the 69th World Health Assembly prepares to meet in Geneva May 23-28, members from four global commissions that examined the response to the Ebola epidemic have consolidated their findings in a new report, and identified three key areas of focus for greater global health security.

Writing in PLOS Medicine, the authors, led by Lawrence O. Gostin of the O’Neill Institute for National and Global Health Law at Georgetown University, say the key needs are to 1) strengthen national health systems, 2) consolidate and strengthen World Health Organization (WHO) emergency and outbreak response activities, and 3) enhance research and development.

The 11 authors on the PLOS Medicine report were members of four global commissions: the World Health Organization Ebola Interim Assessment Panel, the Harvard University and the London School of Hygiene & Tropical Medicine’s Independent Panel on the Global Response to Ebola, the Commission on a Global Health Risk Framework for the Future (CGHRF), and the United Nations High-Level Panel on the Global Response to Health Crises.

"Our recommendations represent an urgent call to action for the World Health Assembly to act decisively," says Gostin, who served on two of the commissions and advised on a third. "The Assembly has a historic opportunity to make global health security a priority, ensuring that WHO can regain its status as the global health leader."

He called on the Assembly to "give WHO a mandate for global health security, provide robust resources, and hold the Director General fully accountable for keeping the world safe from epidemics."

Gostin and the authors point out the need for robust national health systems that are prepared to face fast-spreading infectious diseases. "As outbreaks stretch existing resources, resilient systems that are designed to ensure surge capacity in health emergencies are needed," they write.

But “If national health systems are the foundation for global health security, WHO is at the apex,” the authors say, and they point out that all four commissions unanimously recommended that WHO “create a Centre for Emergency Preparedness and Response (CEPR), integrating and strengthening all its preparedness, response, and humanitarian activities.”

Gostin and the others note that the WHO can't go at it alone. "It is unconscionable to issue a mandate for WHO that it can't achieve due to lack of support from the member nations issuing the mandate," Gostin says. "If WHO fails to lead for that reason, the responsibility will lie with its member states."

Finally, the authors note major hurdles in research and development: “The paucity of medical technologies stem primarily from low commercial priority, limited funding, and practical challenges of conducting human trials for episodic infections.”

Recommendations for improving R&D focus primarily on funding for diagnostic tests, vaccines and therapies. However, one essential step to progress is the need for the WHO to renegotiate and broaden the Pandemic Influenza Preparedness Framework that requires member states to share biological materials. The treaty allows those states to receive benefits of the research, such as therapies or vaccines, in exchange for biological materials, but is limited to pandemic influenza, not to other novel pathogens.

The authors note that the proposals made by the four commissions "are ambitious, with action needed everywhere from civil society and research laboratories to Geneva and national capitals," the authors conclude. "It would be a reckless disregard for human life and security to resist vital reforms."

The O'Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy. Its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public's health, using objective evidence as a measure. The O'Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives.